Six biomarkers predict AMD progression with greater certainty than ‘large drusen’ sign
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Key takeaways:
- Six biomarkers had greater predictive ability than the classic ‘large drusen’ sign.
- Intraretinal hyper-reflective foci and hypo-reflective drusen cores were associated with progression to geographic atrophy.
Researchers have identified biomarkers that predict age-related macular degeneration progression as well as biomarkers associated with progression to geographic atrophy and neovascularization, according to a review published in Ophthalmology Retina.
“This systematic review and meta-analysis provides guidance as to which OCT prognostic biomarkers are most relevant for predicting the risk of progression to late AMD,” Matt Trinh, PhD, and colleagues from the School of Optometry and Vision Science at University of New South Wales, wrote. “Amongst 114 OCT biomarkers with reported or calculable risk, six biomarkers demonstrated high certainty of evidence and greater predictive ability than the classic ‘large drusen’ sign.”
Using PubMed and Embase, the researchers assessed eligible studies following the Grade of Recommendations, Assessment, Development and Evaluation approach. The primary outcome of interest was quantified risk for progression from early or intermediate AMD to late AMD.
The researchers identified 114 quantified OCT biomarkers from 47 studies, finding that the greatest magnitudes of prediction to late AMD were external limiting membrane abnormality, interdigitation zone abnormality, ellipsoid zone abnormality, concurrent large drusen and reticular pseudodrusen, hypo-reflective drusen cores, intraretinal hyper-reflective foci and large drusen.
Furthermore, intraretinal hyper-reflective foci and hypo-reflective drusen cores were associated with greater risk for geographic atrophy, while ellipsoid zone abnormality was associated with neovascularization.
“Other OCT biomarkers such as drusenoid [pigment epithelium detachment], shallow irregular [retinal pigment epithelium] elevations and nascent geographic also exhibited large magnitudes of risk but require further studies for validation,” Trinh and colleagues wrote. “Future studies should consider assessing how the copresence of these biomarkers may affect risk predictions.”
Perspective
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In recent years, management of AMD has drastically changed as new treatment interventions have expanded our view on the disease. When considering advanced disease, consisting of formation of choroidal neovascular membrane or geographic atrophy, preserving vision and slowing progression can be a daunting task.
Recent innovations, including newer anti-VEGF intravitreal injections (Vabysmo [faricimab-svoa, Genentech], Byooviz [ranibizumab-nuna, Biogen/Samsung Bioepis], Beovu [brolucizumab-dbll, Novartis]) and development of intravitreal therapies for slowing geographic atrophy (Izervay [avacincaptad pegol intravitreal solution, Iveric Bio], Syfovre [pegcetacoplan injection, Apellis]), have allowed us to offer an enhanced level of care to our patients. As a clinician, what this article shows us is that we are able to better detect patients with early and intermediate disease who are at greatest risk for progression to advanced disease.
By identifying specific OCT prognostic biomarkers we can ensure at-risk patients have an appropriate follow-up period such that disease progression can be identified at an earlier stage. This is significant in our clinical practices because prior to this we typically followed general guidelines where patients with early disease were monitored yearly, and those with intermediate disease were monitored biannually.
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